MEDICARE: BENJAMIN MAGGA ACUPUNCTURE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1285185272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENJAMIN MAGGA ACUPUNCTURE LLC

Provider Business Mailing Address
First Line	:	4203 SE HAWTHORNE BLVD
Second Line	:	SUITE A
City	:	PORTLAND
State	:	OR
Zip	:	97215-3160
Country	:	US
Telephone Number	:	503-970-6321
Fax Number	:

Provider Business Practice Location Address
First Line	:	4203 SE HAWTHORNE BLVD
Second Line	:	SUITE A
City	:	PORTLAND
State	:	OR
Zip	:	97215-3160
Country	:	US
Telephone Number	:	503-970-6321
Fax Number	:

Authorized Official
Title or Position	:	LICENSED ACUPUNCTURIST
Name	:	BENJAMIN MAGGA
Credential	:	L.AC.
Telephone Number	:	503-970-6321

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	10/14/2016

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